Jin, Mauricio F.

Lay Summary This multicenter study evaluated clinical outcomes in pregnancy for women with ulcerative colitis and an ileal pouch-anal anastomosis. Close monitoring is needed with a multidisciplinary team for management of inflammatory complications of the pouch such as pouchitis in pregnancy and postpartum.

ABSTRACT Lymphocytic colitis (LC) is a subtype of microscopic colitis, often associated with chronic watery diarrhea and characterized by an increase in intraepithelial lymphocytes. Although various medications are implicated in drug-induced LC, its incidence as a treatment-related adverse effect of rearrangement during transfection-selective tyrosine kinase inhibitors is not known. We report a case of pralsetinib-induced LC in a patient with stage 3c nonsmall cell lung cancer. This case highlights pralsetinib-induced LC as a cause of persistent diarrhea that is refractory to standard antidiarrheal treatments and prompts gastrointestinal evaluation and histopathological examination to facilitate early diagnosis and management.

Ischemic monomelic neuropathy (IMN) is a rare peripheral neuropathy caused by limb ischemia and subsequent nerve degeneration, typically manifesting with unilateral pain, paresthesia, and numbness without overt signs of limb ischemia. This case report describes a 59-year-old female with extensive peripheral artery disease who developed IMN in her right lower extremity following an acute, intraoperative in-sheath thrombosis during a right femoral endarterectomy and external iliac artery stent placement, a rare etiology distinct from the more commonly reported associations with bypass surgery or hemodialysis access. Despite successful intraoperative revascularization, the patient developed diminished motor and sensory function with unremitting pain, and subsequent electromyography confirmed a length-dependent neuropathy with features of denervation, consistent with IMN. This case underscores the critical need for clinicians to consider IMN in the differential diagnosis of post-procedural neuropathic pain, even in the absence of classic ischemic signs and following seemingly successful vascular interventions, as acute thrombotic events during vascular procedures can precipitate this debilitating condition.

Introduction: Glucagon-like peptide-1 (GLP-1) receptor agonists (GLP1RAs) are increasingly used to treat obesity and other metabolic conditions; however, they are known to inhibit gastrointestinal motility. Since gastrointestinal microbial overgrowth (MO) can arise in states of intestinal stasis, we sought to investigate the potential association between GLP1RA use and MO. Methods: We analyzed data from 99 patients prescribed GLP1RAs who subsequently underwent testing for MO via intestinal aspirate culture or glucose or lactulose breath tests. Results: Most patients had diabetes. Among patients who underwent culture, 76.2% tested positive for small intestinal bacterial overgrowth (SIBO) at a threshold of ≥10³ CFU/mL, with a significant association found between proton pump inhibitor (PPI) use and SIBO. At ≥10 5 CFU/mL, 33.3% tested positive for SIBO, and neither PPI use nor surgical history was associated. Breath testing revealed a 30.6% positivity rate for MO, predominantly characterized by intestinal methanogen overgrowth (IMO). There was no association between control of diabetes and positive MO tests. Conclusion: GLP1RA use is associated with SIBO, although diabetes may be a confounder.

Abstract: Background: Botanicals are increasingly incorporated into skincare products. Although allergic contact dermatitis due to botanicals is recognized, data describing the prevalence of positive patch tests to botanicals are sparse. Objective: To report the Mayo Clinic experience of patch testing to selected botanical products in the standard, extended standard, fragrance, and plant series. Methods: IRB-approved retrospective study of the Mayo Clinic experience with patch testing to botanicals from 1997 to 2017. Results: In total, 12,169 people were patch tested to botanicals in the standard, extended standard, fragrance, and plant series; 4032 were men and 8137 were women. The mean age of the population tested was 54 (standard deviation 17.7) years. Almost 11% (1320/12,169) of the patch-tested population exhibited positive reactions to at least 1 botanical agent. Myroxylon pereirae resin 25% was the most common positive allergen in the series. Patients who had positive reactions to at least 1 botanical agent were more (19.8%) likely to have a positive reaction to at least 1 additional botanical than those patients who did not have any positive tests. Most patients presented with generalized involvement (334) or involvement of the hands (284) or face (232). Conclusion: Physicians should be aware of the high prevalence of allergic contact dermatitis and patch test positivity associated with botanical products.

AbstractBackgroundFollicular mucinosis (FM) is a rare disease characterized by mucin accumulation in the follicular unit. FM's etiology is still widely debated since its first description in 1957. Follicular mucinosis is usually reported to be benign in children, although reports of malignant transformation, most commonly mycosis fungoides, exist. The present project aims to demonstrate that children with a diagnosis of follicular mucinosis have positive long‐term outcomes and do not develop mycosis fungoides.Materials and methodsThis is a retrospective cohort study where patients with a diagnosis of follicular mucinosis ages 22 years and below were identified. Data surrounding the patient's diagnosis of FM, differential diagnosis, treatments, and long‐term outcomes were collected. Patients who were lost to follow‐up were contacted by phone for an update on the status of their skin and overall health.ResultsOut of 14 patients with follow‐up information, none developed subsequent mycosis fungoides or other hematologic malignancies.ConclusionPediatric patients with follicular mucinosis will likely present with limited disease and not experience malignant transformation.

Abstract Background Ileal pouch–anal anastomosis (IPAA) is the standard restorative procedure following proctocolectomy in patients with inflammatory bowel disease (IBD) who require colectomy. However, removal of the diseased colon does not eliminate the risk of pouch neoplasia. We aimed to assess the incidence of pouch neoplasia in IBD patients following IPAA. Methods All patients at a large tertiary center with International Classification of Diseases–Ninth Revision/International Classification of Diseases–Tenth Revision codes for IBD who underwent IPAA and had subsequent pouchoscopy were identified using a clinical notes search from January 1981 to February 2020. Relevant demographic, clinical, endoscopic, and histologic data were abstracted. Results In total, 1319 patients were included (43.9% women). Most had ulcerative colitis (95.2%). Out of 1319 patients, 10 (0.8%) developed neoplasia following IPAA. Neoplasia of the pouch was seen in 4 cases with neoplasia of the cuff or rectum seen in 5 cases. One patient had neoplasia of the prepouch, pouch, and cuff. Types of neoplasia included low-grade dysplasia (n = 7), high-grade dysplasia (n = 1), colorectal cancer (n = 1), and mucosa-associated lymphoid tissue lymphoma (n = 1). Presence of extensive colitis, primary sclerosing cholangitis, backwash ileitis, and rectal dysplasia at the time of IPAA were significantly associated with increased risk of pouch neoplasia. Conclusions The incidence of pouch neoplasia in IBD patients who have undergone IPAA is relatively low. Extensive colitis, primary sclerosing cholangitis, and backwash ileitis prior to IPAA and rectal dysplasia at the time of IPAA raise the risk of pouch neoplasia significantly. A limited surveillance program might be appropriate for patients with IPAA even with a history of colorectal neoplasia.

BACKGROUND Ibrutinib, an irreversible Bruton tyrosine kinase inhibitor, has been associated with an increased risk of bleeding. There is a paucity of data on the risk of bleeding in patients on ibrutinib undergoing dermatologic surgery. OBJECTIVE To determine the frequency of bleeding complications associated with ibrutinib in patients undergoing dermatologic surgery. MATERIALS AND METHODS A retrospective, single-center, case–control study of patients on ibrutinib undergoing skin surgery between January 2013 and March 2020 compared with sex, disease, and age-matched control patients undergoing cutaneous surgeries. RESULTS A total of 75 surgeries performed on 37 case patients and 116 surgeries performed on 64 control patients were included. Ibrutinib was associated with a statistically significant increased rate of bleeding events (6/75 [8%] vs 1/116 [0.8%], p -value = .02). Compared with ibrutinib patients who did not have a bleeding event, those on ibrutinib who suffered bleeding were all men, older (mean age 82.7 vs 73.0, p -value= .01), and had lower mean platelet counts (104.0 vs 150.5 K/μL, p -value = .03). CONCLUSION Ibrutinib may be associated with increased risk of bleeding in patients with hematologic malignancies, particularly older men with lower platelet levels and on multiple anticoagulants. Transient discontinuation of ibrutinib should be considered for dermatologic surgeries.